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我们是否应该允许器官捐献安乐死?为最大化移植器官数量和质量的替代方案。

Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation.

机构信息

University of Oxford University, UK.

出版信息

Bioethics. 2012 Jan;26(1):32-48. doi: 10.1111/j.1467-8519.2010.01811.x. Epub 2010 May 3.

Abstract

There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives.

摘要

目前可用的器官来源有限,无法满足器官衰竭患者的需求。每年都有成千上万的患者在等待移植的名单上死亡。然而,有一种目前可用的、未充分利用的潜在器官来源。许多患者在重症监护室停止维持生命的治疗后死亡,他们的器官本可以用于拯救其他人的生命。目前,这些器官中的大多数都被浪费了。在本文中,我们考虑并评估了一系列方法来增加这群患者可提供的器官数量和质量。改变同意安排(例如死后器官征募)或改变器官捐赠实践可能会大大增加可用器官的数量,但这与目前管理移植的公认规范相冲突。我们认为,一种替代方案,即器官捐赠安乐死,将是对目前停止生命支持实践的一种合理改进。它将使个人在死后能够最大程度地有机会用自己的器官帮助他人。它将增加患者的自主权。它将减少临终过程中的痛苦机会。我们认为,在重症监护中停止生命支持时,应给予患者选择是否以及如何捐赠器官的权利。继续目前的移植实践是以死亡和延长器官衰竭为代价的。我们应该认真考虑所有的替代方案。

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